Certified Inpatient Coding (CIC) Practice Exam

What is the primary component needed to determine a MS-DRG?

1. The birth weight of a neonate

2. The length of stay

3. Principal diagnosis

4. Discharge status

The correct answer is: Principal diagnosis

The correct answer is the principal diagnosis, as it serves as the main factor in determining the Medicare Severity Diagnosis Related Groups (MS-DRGs). The principal diagnosis identifies the condition that is chiefly responsible for the patient's admission to the hospital. This classification directly influences the MS-DRG assignment, as it establishes the reason for the patient's hospitalization and aligns with the relevant coding guidelines. While other factors, such as the length of stay, discharge status, and even birth weight for neonates, may play a role in the overall management of a patient's care or in specific DRG assignments, they do not hold the same level of significance in establishing the primary MS-DRG classification. The principal diagnosis determines the most appropriate MS-DRG by correlating with hospital billing and reimbursement processes to ensure accurate capturing of patients' medical conditions and the resources utilized during their treatment.